A facility determined by the director to meet the definition of a nonsignificant categorical user as defined by BMC 15.14.012 must complete the below statement and submit it to the director annually. The statement must be signed by an authorized representative of the user as defined by BMC 15.14.012.

Based on my inquiry of the person or persons directly responsible for managing compliance with the categorical Pretreatment Standards under 40 CFR ________, I certify that, to the best of my knowledge and belief that during the period from _______________________ to _____________________ [months, days, year]:

(a) The facility described as ______________________________ [facility name] met the definition of a nonsignificant categorical user as defined in Bellingham Municipal Code Section 15.14.012;

(b) The facility complied with all applicable Pretreatment Standards and requirements during this reporting period; and

(c) The facility never discharged more than 100 gallons of total categorical wastewater on any given day during this reporting period.

This compliance certification is based upon the following information: _________.